Hiv associated nephropathy (hivan)

HIV nephropathy kidney diseases in hiv and aids

1. HIV-associated Nephropathy (HIVAN) By a Final Year Medical Student

2. HIVAN is renal disease that occurs in patients with HIV disease. HIVAN can result from direct kidney infection with HIV or from the adverse effects of antiretroviral drugs. Patients with HIV are at increased risk of developing prerenal azotemia due to volume depletion resulting from salt wasting, poor nutrition, nausea or vomiting. There is no reliable data on the incidence and causes of acute HIV-related renal disease in Africa. HIVAN is predominantly observed among Africans

3. Pathogenesis Predisposition: Myosin heavy chain 9 (MYH9) gene in African Americans Mechanism : Direct damage by HIV – podocyte injury, Proliferation and drop out Collapse of the glomerulus 2. Immune complex deposition

4. Types of renal disease in HIV Collapsing focal glomerulosclerosis (FSG) – most common(80-90%), primary form of HIVAN Pre-renal/Acute Tubular Necrosis – Drugs(Amphotericin B, Aminoglycosides, Tenofovir ), Sepsis, Opportunistic Infections(OIs) Post-infectious glomerulonephritis Membranous glomerulonephritis – Hepatitis B, syphilis, malaria, schistosomiasis etc Membranoproliferative – Hepatitis C, HIV Interstitial nephritis – bacitracin, rifampicin Immune complex glomerulonephritis – deposition of IgA directed against HIV antigen

5. HIV-associated FSG Pathogenesis Direct infection of glomerular epithelial and mesangial cells; tubular cells Stimulates release of fibroblast growth factor and TGF-β → Matrix accumulation, fibrosis, tubular injury Possible genetic component: More common on blacks Histology Collapse and sclerosis of the entire glomerular tuft, rather than segmental injury Often severe tubular injury Podocyte proliferation It associated with loss of podocyte-specific markers due to HIV-1 infection of the podocytes Clinical Proteinuria → nephrotic syndrome Oedema, ‘bland’ urine. Hypertension is unusual. ↑ echogenicity and normal-sized kidneys on U/S Normotensive Progressive course – if untreated patients go on to renal failure

6. Management Highly active antiretroviral therapy(HAART) may result in stabilization of renal function and prevention of progression to end-stage renal failure(efficacy of 23%) and HIV-associated mortality in patients with end-stage renal failure.

7. References Kumar & Clark 8 th edition Medscape Uptodate More information available on medstudent2medstudent.wordpress.com Prepared by @ kyle_kats on Twitter.